Endocrine and glycaemic emergencies Flashcards
Explain fluid therapy in DKA?
Adults:
Shocked - 500ml over 15 mins (Repeat once again over 15min if patient remains hypotensive OR repeat dose over 45 min if blood pressure restored)
Dehydrated - 500ml over 30 mins/1000ml over 1 hour
Young adults:
If shocked 20ml/kg over 15mins
Paeds:
Shocked- 10ml/kg over 15 mins. Discuss with CHUB for repeat doses
Dehydrated - 10ml/kg over 30 mins
What is the fluid indication for adrenal crisis?
Normal intravascular fluid therapy for medical emergencies, for adults:
250ml PRN boluses to maintain systolic >90mmHg
What symptoms distinguish mild to moderate hypoglycaemia from severe hypoglycaemia?
Severe:
GCS≤8, convulsing, very aggitated or aggresive, comatose
Moderate:
Conscious and able to swallow but may be confused or disorientated
Mild:
Conscious, orientated and able to swallow
What differences may be seen in the presentation of DKA vs HHS?
DKA:
High ketones (on monitor or ketone breath)
Kussmaul breathing
Abdominal pain
Can be only slightly raised BM
HHS:
Fatigue
Altered level of consciousness
Usually very marked BM
Both can have reduced GCS, urinary changes, fatigue, hypovolaemia etc.
Ketone levels are the only sure way to differentiate
What are the general symptoms of hyperglycaemia?
SoB
Tachycardia
Hypotension
Pyrexia
Dehydration
Thirst
Polyuria
Generally unwell
What kinds of patients are more susecpitble to adrenal crisis?
It should be considered in patients who have a history of:
-Known primary adrenal insufficiency
-Hypopituitarism (any known pituitary hormone deficit or clinical features indicating increased risk), or
-Previous or current prolonged course (2-4 weeks) of steroid therapy
Adrenal crisis may also be the first presentation of underlying adrenal insufficiency or there may be a history suggestive of chronic hypoadrenalism